Review article: benefits and risks of chemotherapy in elderly patients with metastatic colorectal cancer.
BACKGROUND
Although metastatic colorectal cancer (mCRC) is largely a disease of older individuals, our understanding of disease processes and their optimal treatment has been gained through trials with populations largely confined to younger individuals.


OBJECTIVE
To identify through a review issues specific to geriatric patients with mCRC (physiological changes associated with aging, burden of coexisting illnesses, altered drug pharmacokinetics and functional impairment) and assess challenges to elderly patients posed by malignancy and exposure to cytotoxic medication.


METHODS
Our literature search for indexed articles published between 2000 and May 2008 employed terms including irinotecan, oxaliplatin, elderly, mCRC, targeted agents and biologicals.


RESULTS
Underrepresentation of older patients in clinical trials makes it difficult to extrapolate findings to older age groups. However, some trials have demonstrated that elderly patients can achieve survival benefits and toxicity comparable to younger patients, although dosage modifications may be required.


CONCLUSIONS
Currently, benefits with pharmacological therapy are suggested but not proven in the elderly population. Although concurrent illnesses and disabilities can complicate treatment decision making, chronological age alone should not disqualify these patients with mCRC from receiving optimal treatment similar to that offered to their younger cohorts.
Mitry
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E
UFR Médecine Paris Ile de France Ouest, Université Versailles Saint-Quentin, EA4340, Hôpital Ambroise Paré, APHP, Boulogne, France. emmanuel.mitry@apr.aphp.fr
Rougier
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P
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D002986:Clinical Trials as Topic; D015179:Colorectal Neoplasms / Q000188:drug therapy*; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D009362:Neoplasm Metastasis / Q000188:drug therapy; D012307:Risk Factors; D016896:Treatment Outcome
D000970:Antineoplastic Agents